Provider Demographics
NPI:1902418650
Name:LILY CENTER CHICAGO L.L.C.
Entity Type:Organization
Organization Name:LILY CENTER CHICAGO L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PECYNA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-336-3113
Mailing Address - Street 1:125 S WACKER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-4421
Mailing Address - Country:US
Mailing Address - Phone:630-336-3113
Mailing Address - Fax:
Practice Address - Street 1:125 S WACKER DR STE 300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-4421
Practice Address - Country:US
Practice Address - Phone:630-336-3113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09142576OtherILLINOIS SECRETARY OF STATE